Chest

Chest

Volume 135, Issue 3, Supplement, March 2009, Pages 42S-48S
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CME: ACCP Evidence-Based Educational Guidelines
Continuing Medical Education Effect on Practice Performance: Effectiveness of Continuing Medical Education: American College of Chest Physicians Evidence-Based Educational Guidelines

https://doi.org/10.1378/chest.08-2517Get rights and content

Background

There has been sizable debate and widespread skepticism about the effect of continuing medical education (CME) on the performance of physicians in the practice setting. This portion of the review was undertaken to examine that effect.

Methods

The guideline panel used data from a comprehensive review of the effectiveness of CME developed by The Johns Hopkins Evidence-based Practice Center, focusing on the effect of CME on clinical performance.

Results

The review found 105 studies, which evaluated the impact of CME on short- and long-term physician practice performance. Nearly 60% met objectives relative to changing clinical performance in prescribing; screening; counseling about smoking cessation, diet, and sexual practices; guideline adherence; and other topics. Single live and multiple media appeared to be generally positive in their effect, print media much less so. Multiple educational techniques were more successful at changing provider performance than single techniques. The amount or frequency of exposure to CME activities appeared to have little effect on behavior change.

Conclusions

Overall, CME, especially using live or multiple media and multiple educational techniques, is generally effective in changing physician performance. More research, however, is needed that focuses on the specific types of media and educational techniques that lead to the greatest improvements in performance.

Section snippets

Summary of Recommendations

  • 1.

    General: We recommend that CME interventions be used to improve physician practice performance (Grade 1C).

  • 2.

    Instructional media:

    • a.

      We recommend that both single live and multiple media be used to maintain or improve physician practice performance (Grade 1C).

    • b.

      We recommend that print media should not be used alone to improve physician practice performance (Grade 1C).

  • 3.

    Instructional techniques: We recommend that multiple instructional techniques be used to improve or maintain physician practice

Materials and Methods

The guideline panel reviewed the evidence tables and comprehensive review of the effectiveness of CME developed by The Johns Hopkins Evidence-based Practice Center (EPC), which is detailed in the methods article.2a For this article, we focused on the effect of CME on physician practice performance. These effects were measured in either the short term (< 30 days after an intervention) or the long term (ā‰„ 30 days postintervention). The panel noted several limitations in the methods of the EPC

Overall Effects of CME on Clinical Performance

The review identified 105 studies, which evaluated the impact of CME on short- and long-term physician practice performance. The majority (61 studies, 58%) met practice objectives. A wide mix of objectives was studied, including prescribing; screening; counseling about smoking cessation, diet, and sexual practices; guideline adherence; and others. Fifty studies3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38,

Discussion

It has long been accepted that CME is an important educational intervention for the improvement of practice performance in health care, but the evidence from previous systematic reviews and other data offers less than strong support to this belief.1, 2, 112 Direct comparisons between the EPC review and these studies is made problematic by the EPC's inclusion of self-reported performance outcomes in some studies. This use of self-report with its potential for bias is in contrast to other

Conflict of Interest Disclosures

Dr. Davis has received grants from the university of Toronto for the redevelopment of a database and $100,00 in grants from the Ministry of Health, Ontario, Canada.

Dr. Galbraith has no conflicts of interest to disclose.

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